Blog Anke van Engen
The annual NHS drug bill stands at £13.8bn per annum1, and NICE has estimated that £4bn of medicines are not used correctly2. With the successful treatment of a disease depending on consistent use of medicines as prescribed, non-adherence is a pertinent issue for all healthcare stakeholders. Patients who do not adhere to their treatment are also at risk of increased hospitalization, resulting in further unnecessary costs to the healthcare economy. 

We have spoken in previous blogs about the value relationship that needs to exist between biopharma and the NHS (both payers and providers), and the need for biopharma to help those payers and providers develop confidence to use a new product. Biopharma needs to address two related, but different, concerns:

  1. Biopharma will more likely be effective in increasing the NHS’s confidence to use a new medication if it has made a commitment to understand the pathway in which it will be deployed and the challenges that will be faced to ensure real-world adherence. 
  2. Without supporting real-world adherence biopharma cannot provide the consistent evidence required that their product is able to achieve the patient outcomes that the wider NHS needs to see to have confidence in a new medication. 
As well as demonstrating strong clinical outcomes, biopharma must show a commitment to support and improve adherence if it is to gain widespread adoption on payer formularies. In this outcomes-focused era, payers are looking for economic and clinical value data in order to justify the use of a drug and manage uncertainty, and without localized data on medication adherence to differentiate a drug from its competitors, payers are more likely to opt for products that have historically been able to better demonstrate strong clinical outcomes. 

Providing payer support 

The need to invest in improving adherence has generally been acknowledged by payers. Biopharma is often expected to cover the cost of formal adherence support, as part of its growing responsibility to think ‘beyond the pill’. Barriers for truly effective patient adherence and engagement programs remain, due to:

  • A ‘one size fits all’ approach
  • Poor understanding of a patient’s wider needs 
  • Lack of patient centricity 
  • Lack of connectivity across multiple patient touch-points 
Addressing the adherence challenges: Local data 

The most successful adherence strategies are tailored to the patient rather than the disease. To get as close as possible to meeting the needs of the patient, biopharma must utilize mechanisms for identifying non-adherent patients within a local pathway in order to measure the extent of their non-compliance. This can be achieved by sourcing local data to analyze core pathway frailties that may be contributing to non-adherence, presenting solutions to improve that core pathway.Nurse audits and outcomes evaluations can delve deeper into real-world data using the insight and experience of in-the-field staff within that local health economy, further exploring what motivates individual patients to adhere or not. These tools can inform biopharma-led support services and patient support programs designed to improve the core pathway. 

Locally sourced data can include

  • Hospital episode statistics (HES)
  • Patient reported outcomes (PROMS) 
  • Patient reported experience measures (PREMS) 
  • Patient level clinical notes 
  • Local health systems (e.g. diagnostics etc). 
Quality of Life (QoL) is very often an underlying factor in non-adherence and therefore also needs to be analyzed to ensure that patient needs are met and not just the needs of clinicians. 

The power of patient centricity 

Alongside real-world data, biopharma must also analyze patient characteristics to solve the adherence puzzle. There are a number of personal, patient-specific reasons for non-adherence, and these can be intentional or unintentional. Physical reasons can include unpleasant side effects of the drug, and psychological reasons could be that the patient does not want to accept they have the condition. A patient’s support network and co-morbidities can play a huge role in their motivation, and their individual circumstances must be taken into account. So it is important to provide bespoke adherence support programs that manage the patient within their individual circumstances as well as within the spectrum of their disease. 

Conclusion 

Localized data can support biopharma in its commitment to identifying and improving sub-optimal pathway adherence. Tools such as outcomes audits and evaluations and health informatics can allow biopharma to analyze core pathway frailties and patterns that are contributing to non-adherence within specific patient cohorts. Adherence issues can then be tackled in a number of ways, for example by pathway redesign or instigating patient engagement programs. The success of such programs can also be demonstrated in the local, real-world data that payers require for proving the outcomes of a drug in the local health economy. This helps biopharma to gain adoption on payer formularies faster, and also demonstrates a longer-term commitment to adherence that will improve its relationship with the NHS. 

If biopharma can prove that it understands why patients are non-adherent within a specific pathway, and demonstrate how its product can solve this problem, it can open up a number of market access opportunities such as joint working projects with the NHS. Successful market access depends on biopharma’s use of localized data to prove that its products can add additional value. 

To find out more about how an improvement in patient adherence would positively impact the wider health economy and the outcomes of the ‘Triple Aim’ – download the Quintiles white paper "Influencing patient adherence in an outcomes focused era". 

  1. Shaw, V., 2014. Clinical leaders: Pharma on the front line. Health Service Journal. [Online] http://www.hsj.co.uk/resource-centre/supplements/clinical-leaders-pharma-on-the-front-line/5072260.article#.VP2kWxjtmko [Accessed February 18th, 2015].  
  2. NICE. 2009. Costing statement: Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence.